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With these cuts, they may die

"With these cuts, they may die" Continued...

Issue: "Libyan exodus," March 26, 2011

Kay Warren, wife of pastor Rick Warren and head of California-based Saddleback Church's international AIDS efforts, has jumped in too. "I'll use whatever influence I have to keep PEPFAR alive," she told me. Saddleback doesn't receive any money from PEPFAR, but Warren has long been a public cheerleader for it: "Everybody's budget got cut so every constituency is going to be calling," said Warren. "I completely understand that this is a time for our nation that we have to make cuts in spending, but I would argue not for the most vulnerable." She said she plans to meet with lawmakers soon.

But the 87 new Republican members in the House have a singular focus-to cut spending. When Rep. Joe Barton, R-Texas, touted $61 billion in cuts the House proposed for this fiscal year at a Tea Party summit in Phoenix last month, the audience booed him, chanting, "More, more, more!"

And despite its popularity among conservatives during the Bush years, PEPFAR has few advocates in the new Congress: Only one House member and three senators who originally sponsored the initiative are still in office. "They don't know the history, they don't know the context and they don't know the success," said Michael Gerson, former Bush senior policy adviser.

Instead it's Democrats who defend Bush's program: "Our global health programs represent some of our most successful and effective international policies," said Sen. John Kerry, D-Mass., chair of the Senate Foreign Relations Committee and one of the original sponsors. "The proposed cuts in the House spending package would have devastating implications for these policies and for our humanitarian agenda as a whole. Simply put, these cuts will cost lives."

Sen. Richard Lugar of Indiana was one of the original Republican sponsors, but his senior adviser Mark Helmke was cautious: The senator is "taking a hard look" at the cuts, he said. Lugar is facing the prospect of a more conservative primary challenger in 2012, who could attack the senator's efforts to preserve spending.

The Bush administration designated the foreign aid budget, including PEPFAR, as national security spending, which could protect it from the congressional axe. House Republicans changed that designation in the spending bill to cover the rest of this fiscal year. House Budget Committee Chairman Paul Ryan, R-Wis., explained: "What ends up happening in these budget games is they try to sweep everything into these more protected categories so they can get higher levels. . . . So look, let's call things for what they are. If it's a high priority, it should be able to stand on its own merit. And we shouldn't shield this category of spending in a higher priority where it really doesn't belong."

Secretary of State Hillary Clinton argues that the nature of wars today means that aid and development are critical components of national security. Ryan acknowledged he and Clinton discussed that, but said they "have a difference of opinion." An argument could be made for foreign aid in Afghanistan and Pakistan counting as national security spending, he said, but added, "I just don't think global health, as important as that may be, or the French ambassador's residence, belong in this national security budget."

Given pressure from House Republicans, PEPFAR officials have said they will make it a priority with whatever money they do have to continue providing drugs to those already on ARVs. The drugs cannot be stopped and restarted but must be taken in a carefully prescribed regimen.

Worse, if the patient doesn't complete treatment, the virus will mutate and become resistant to the drugs, making them "worthless," explained Stephens, who grew up in Zimbabwe watching his father work as a physician at Karanda before becoming a physician there himself. Drug resistance is a particular problem in Africa because doctors have about five drugs to work with for treating HIV/AIDS, he said. In the United States physicians have about two dozen drugs. So if a patient becomes drug resistant in Africa, fewer options remain for life-saving treatment.

The cuts could also unravel PEPFAR's progress toward making African countries' government health ministries self-sustaining. PEPFAR staff members sometimes work directly alongside local health officials to improve their institutions and safeguard against corruption. South Africa, which has 17 percent of the world's HIV/AIDS population, is the valedictorian of that effort. The United States has provided hundreds of millions of dollars to treat patients there, but now the country is "moving from emergency to sustainability," according to PEPFAR country director Mary Fanning. South Africa plans to be fully self-funded for AIDS programs by 2015.

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